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This form allows Dr. deRamón to do a preliminary review of your case online. Please fill out the form to initiate this process. After filling out the form, use the tool provided below in step 2 to send photos of your case to Dr. deRamón for evaluation. We will review your case and contact you as soon as possible to go over your surgical options. Thank you for contacting our practice.

Please answer all questions

Patient Name:
E-mail Address:
Phone Number:
1. List in priority the things you would most like to improve about your image.

2. Have you had any previous cosmetic surgery? (If no, go to question #3)

a. What was the reason for your surgery?

b. When was your last surgery performed?

c. Who did your surgeries? (name of doctor and specialty)

3. If you have not had another surgery, what are your realistic desires, i.e., what will/would it take for you to be satisfied with the outcome? Think about this and be honest.